|
BLADE MINI 62 12877
|
Facility
|
IP
|
$85.00
|
|
| Hospital Charge Code |
2971253
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
BLADE MYRINGOTOMY MICROEDGE DOUBLE CUTTING EDGE ARROW DISP BL-0150
|
Facility
|
IP
|
$350.00
|
|
| Hospital Charge Code |
2965296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
BLADE MYRINGOTOMY MICROEDGE DOUBLE CUTTING EDGE ARROW DISP BL-0150
|
Facility
|
OP
|
$350.00
|
|
| Hospital Charge Code |
2965296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Aetna Managed Medicare |
$98.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$227.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$175.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.86
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$227.50
|
| Rate for Payer: Quartz Medicare Advantage |
$210.00
|
| Rate for Payer: The Alliance Commercial |
$1,400.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
BLADE OSTEOTOMY SAW HUB STYLE S 80-0740-S
|
Facility
|
IP
|
$1,613.00
|
|
| Hospital Charge Code |
4427963
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$790.37 |
| Max. Negotiated Rate |
$1,483.96 |
| Rate for Payer: Aetna Commercial |
$1,451.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.89
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,483.96
|
| Rate for Payer: Health EOS Commercial |
$1,435.57
|
| Rate for Payer: HFN Commercial |
$1,483.96
|
| Rate for Payer: Multiplan Commercial |
$1,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$967.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.96
|
| Rate for Payer: Quartz Beloit One Network |
$790.37
|
| Rate for Payer: Quartz Commercial |
$967.80
|
| Rate for Payer: WEA Trust Commercial |
$887.15
|
| Rate for Payer: WPS Commercial |
$1,194.75
|
|
|
BLADE OSTEOTOMY SAW HUB STYLE S 80-0740-S
|
Facility
|
OP
|
$1,613.00
|
|
| Hospital Charge Code |
4427963
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.64 |
| Max. Negotiated Rate |
$6,452.00 |
| Rate for Payer: Aetna Commercial |
$1,451.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,387.18
|
| Rate for Payer: Aetna Managed Medicare |
$451.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,048.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$806.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$774.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$854.89
|
| Rate for Payer: Cash Price |
$483.90
|
| Rate for Payer: Cigna Commercial |
$1,483.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$902.63
|
| Rate for Payer: Health EOS Commercial |
$1,435.57
|
| Rate for Payer: HFN Commercial |
$1,483.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,209.75
|
| Rate for Payer: Multiplan Commercial |
$1,290.40
|
| Rate for Payer: NAPHCARE Commercial |
$967.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,483.96
|
| Rate for Payer: Quartz Beloit One Network |
$790.37
|
| Rate for Payer: Quartz Commercial |
$1,048.45
|
| Rate for Payer: Quartz Medicare Advantage |
$967.80
|
| Rate for Payer: The Alliance Commercial |
$6,452.00
|
| Rate for Payer: WEA Trust Commercial |
$887.15
|
| Rate for Payer: WPS Commercial |
$1,194.75
|
|
|
BLADE PACK AM MULTI- PACK AM96BLD5
|
Facility
|
IP
|
$4,450.00
|
|
| Hospital Charge Code |
5729877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,180.50 |
| Max. Negotiated Rate |
$4,094.00 |
| Rate for Payer: Aetna Commercial |
$4,005.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,827.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,358.50
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$4,094.00
|
| Rate for Payer: Health EOS Commercial |
$3,960.50
|
| Rate for Payer: HFN Commercial |
$4,094.00
|
| Rate for Payer: Multiplan Commercial |
$3,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,670.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,094.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,180.50
|
| Rate for Payer: Quartz Commercial |
$2,670.00
|
| Rate for Payer: WEA Trust Commercial |
$2,447.50
|
| Rate for Payer: WPS Commercial |
$3,296.12
|
|
|
BLADE PACK AM MULTI- PACK AM96BLD5
|
Facility
|
OP
|
$4,450.00
|
|
| Hospital Charge Code |
5729877
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,246.00 |
| Max. Negotiated Rate |
$17,800.00 |
| Rate for Payer: Aetna Commercial |
$4,005.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,827.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,246.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,892.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,225.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,136.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,358.50
|
| Rate for Payer: Cash Price |
$1,335.00
|
| Rate for Payer: Cigna Commercial |
$4,094.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,490.22
|
| Rate for Payer: Health EOS Commercial |
$3,960.50
|
| Rate for Payer: HFN Commercial |
$4,094.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,337.50
|
| Rate for Payer: Multiplan Commercial |
$3,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,670.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,094.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,180.50
|
| Rate for Payer: Quartz Commercial |
$2,892.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,670.00
|
| Rate for Payer: The Alliance Commercial |
$17,800.00
|
| Rate for Payer: WEA Trust Commercial |
$2,447.50
|
| Rate for Payer: WPS Commercial |
$3,296.12
|
|
|
BLADE PACK AM SINGLE PACK AM96BLD1
|
Facility
|
IP
|
$4,596.00
|
|
| Hospital Charge Code |
5685892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,252.04 |
| Max. Negotiated Rate |
$4,228.32 |
| Rate for Payer: Aetna Commercial |
$4,136.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,952.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,435.88
|
| Rate for Payer: Cash Price |
$1,378.80
|
| Rate for Payer: Cigna Commercial |
$4,228.32
|
| Rate for Payer: Health EOS Commercial |
$4,090.44
|
| Rate for Payer: HFN Commercial |
$4,228.32
|
| Rate for Payer: Multiplan Commercial |
$3,676.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,757.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,228.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,252.04
|
| Rate for Payer: Quartz Commercial |
$2,757.60
|
| Rate for Payer: WEA Trust Commercial |
$2,527.80
|
| Rate for Payer: WPS Commercial |
$3,404.26
|
|
|
BLADE PACK AM SINGLE PACK AM96BLD1
|
Facility
|
OP
|
$4,596.00
|
|
| Hospital Charge Code |
5685892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.88 |
| Max. Negotiated Rate |
$18,384.00 |
| Rate for Payer: Aetna Commercial |
$4,136.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,952.56
|
| Rate for Payer: Aetna Managed Medicare |
$1,286.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,987.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,298.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,206.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,435.88
|
| Rate for Payer: Cash Price |
$1,378.80
|
| Rate for Payer: Cigna Commercial |
$4,228.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,571.92
|
| Rate for Payer: Health EOS Commercial |
$4,090.44
|
| Rate for Payer: HFN Commercial |
$4,228.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,447.00
|
| Rate for Payer: Multiplan Commercial |
$3,676.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,757.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,228.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,252.04
|
| Rate for Payer: Quartz Commercial |
$2,987.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,757.60
|
| Rate for Payer: The Alliance Commercial |
$18,384.00
|
| Rate for Payer: WEA Trust Commercial |
$2,527.80
|
| Rate for Payer: WPS Commercial |
$3,404.26
|
|
|
BLADE PARALLEL GRAFT KNIFE 10MM AR-2285-10
|
Facility
|
OP
|
$876.00
|
|
| Hospital Charge Code |
5563229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.28 |
| Max. Negotiated Rate |
$3,504.00 |
| Rate for Payer: Aetna Commercial |
$788.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.36
|
| Rate for Payer: Aetna Managed Medicare |
$245.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$569.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$438.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$420.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.28
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$805.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$490.21
|
| Rate for Payer: Health EOS Commercial |
$779.64
|
| Rate for Payer: HFN Commercial |
$805.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$657.00
|
| Rate for Payer: Multiplan Commercial |
$700.80
|
| Rate for Payer: NAPHCARE Commercial |
$525.60
|
| Rate for Payer: Preferred Network Access Commercial |
$805.92
|
| Rate for Payer: Quartz Beloit One Network |
$429.24
|
| Rate for Payer: Quartz Commercial |
$569.40
|
| Rate for Payer: Quartz Medicare Advantage |
$525.60
|
| Rate for Payer: The Alliance Commercial |
$3,504.00
|
| Rate for Payer: WEA Trust Commercial |
$481.80
|
| Rate for Payer: WPS Commercial |
$648.85
|
|
|
BLADE PARALLEL GRAFT KNIFE 10MM AR-2285-10
|
Facility
|
IP
|
$876.00
|
|
| Hospital Charge Code |
5563229
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$429.24 |
| Max. Negotiated Rate |
$805.92 |
| Rate for Payer: Aetna Commercial |
$788.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.28
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$805.92
|
| Rate for Payer: Health EOS Commercial |
$779.64
|
| Rate for Payer: HFN Commercial |
$805.92
|
| Rate for Payer: Multiplan Commercial |
$700.80
|
| Rate for Payer: NAPHCARE Commercial |
$525.60
|
| Rate for Payer: Preferred Network Access Commercial |
$805.92
|
| Rate for Payer: Quartz Beloit One Network |
$429.24
|
| Rate for Payer: Quartz Commercial |
$525.60
|
| Rate for Payer: WEA Trust Commercial |
$481.80
|
| Rate for Payer: WPS Commercial |
$648.85
|
|
|
BLADE PARALLEL GRAFT KNIFE 9MM AR-2285-09
|
Facility
|
OP
|
$876.00
|
|
| Hospital Charge Code |
5496931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.28 |
| Max. Negotiated Rate |
$3,504.00 |
| Rate for Payer: Aetna Commercial |
$788.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.36
|
| Rate for Payer: Aetna Managed Medicare |
$245.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$569.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$438.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$420.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.28
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$805.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$490.21
|
| Rate for Payer: Health EOS Commercial |
$779.64
|
| Rate for Payer: HFN Commercial |
$805.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$657.00
|
| Rate for Payer: Multiplan Commercial |
$700.80
|
| Rate for Payer: NAPHCARE Commercial |
$525.60
|
| Rate for Payer: Preferred Network Access Commercial |
$805.92
|
| Rate for Payer: Quartz Beloit One Network |
$429.24
|
| Rate for Payer: Quartz Commercial |
$569.40
|
| Rate for Payer: Quartz Medicare Advantage |
$525.60
|
| Rate for Payer: The Alliance Commercial |
$3,504.00
|
| Rate for Payer: WEA Trust Commercial |
$481.80
|
| Rate for Payer: WPS Commercial |
$648.85
|
|
|
BLADE PARALLEL GRAFT KNIFE 9MM AR-2285-09
|
Facility
|
IP
|
$876.00
|
|
| Hospital Charge Code |
5496931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$429.24 |
| Max. Negotiated Rate |
$805.92 |
| Rate for Payer: Aetna Commercial |
$788.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$753.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$464.28
|
| Rate for Payer: Cash Price |
$262.80
|
| Rate for Payer: Cigna Commercial |
$805.92
|
| Rate for Payer: Health EOS Commercial |
$779.64
|
| Rate for Payer: HFN Commercial |
$805.92
|
| Rate for Payer: Multiplan Commercial |
$700.80
|
| Rate for Payer: NAPHCARE Commercial |
$525.60
|
| Rate for Payer: Preferred Network Access Commercial |
$805.92
|
| Rate for Payer: Quartz Beloit One Network |
$429.24
|
| Rate for Payer: Quartz Commercial |
$525.60
|
| Rate for Payer: WEA Trust Commercial |
$481.80
|
| Rate for Payer: WPS Commercial |
$648.85
|
|
|
BLADE PATELLA 2108-383
|
Facility
|
IP
|
$2,328.00
|
|
| Hospital Charge Code |
2966100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,140.72 |
| Max. Negotiated Rate |
$2,141.76 |
| Rate for Payer: Aetna Commercial |
$2,095.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,002.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,233.84
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$2,141.76
|
| Rate for Payer: Health EOS Commercial |
$2,071.92
|
| Rate for Payer: HFN Commercial |
$2,141.76
|
| Rate for Payer: Multiplan Commercial |
$1,862.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,396.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,141.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,140.72
|
| Rate for Payer: Quartz Commercial |
$1,396.80
|
| Rate for Payer: WEA Trust Commercial |
$1,280.40
|
| Rate for Payer: WPS Commercial |
$1,724.35
|
|
|
BLADE PATELLA 2108-383
|
Facility
|
OP
|
$2,328.00
|
|
| Hospital Charge Code |
2966100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$651.84 |
| Max. Negotiated Rate |
$9,312.00 |
| Rate for Payer: Aetna Commercial |
$2,095.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,002.08
|
| Rate for Payer: Aetna Managed Medicare |
$651.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,513.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,164.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,117.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,233.84
|
| Rate for Payer: Cash Price |
$698.40
|
| Rate for Payer: Cigna Commercial |
$2,141.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,302.75
|
| Rate for Payer: Health EOS Commercial |
$2,071.92
|
| Rate for Payer: HFN Commercial |
$2,141.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,746.00
|
| Rate for Payer: Multiplan Commercial |
$1,862.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,396.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,141.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,140.72
|
| Rate for Payer: Quartz Commercial |
$1,513.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,396.80
|
| Rate for Payer: The Alliance Commercial |
$9,312.00
|
| Rate for Payer: WEA Trust Commercial |
$1,280.40
|
| Rate for Payer: WPS Commercial |
$1,724.35
|
|
|
BLADE PLASMABLADE PEAK 3.0FR PS210-030S
|
Facility
|
IP
|
$4,791.00
|
|
| Hospital Charge Code |
5459838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,347.59 |
| Max. Negotiated Rate |
$4,407.72 |
| Rate for Payer: Aetna Commercial |
$4,311.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,120.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,539.23
|
| Rate for Payer: Cash Price |
$1,437.30
|
| Rate for Payer: Cigna Commercial |
$4,407.72
|
| Rate for Payer: Health EOS Commercial |
$4,263.99
|
| Rate for Payer: HFN Commercial |
$4,407.72
|
| Rate for Payer: Multiplan Commercial |
$3,832.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,874.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,407.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,347.59
|
| Rate for Payer: Quartz Commercial |
$2,874.60
|
| Rate for Payer: WEA Trust Commercial |
$2,635.05
|
| Rate for Payer: WPS Commercial |
$3,548.69
|
|
|
BLADE PLASMABLADE PEAK 3.0FR PS210-030S
|
Facility
|
OP
|
$4,791.00
|
|
| Hospital Charge Code |
5459838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,341.48 |
| Max. Negotiated Rate |
$19,164.00 |
| Rate for Payer: Aetna Commercial |
$4,311.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,120.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,341.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,114.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,395.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,299.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,539.23
|
| Rate for Payer: Cash Price |
$1,437.30
|
| Rate for Payer: Cigna Commercial |
$4,407.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,681.04
|
| Rate for Payer: Health EOS Commercial |
$4,263.99
|
| Rate for Payer: HFN Commercial |
$4,407.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,593.25
|
| Rate for Payer: Multiplan Commercial |
$3,832.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,874.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,407.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,347.59
|
| Rate for Payer: Quartz Commercial |
$3,114.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,874.60
|
| Rate for Payer: The Alliance Commercial |
$19,164.00
|
| Rate for Payer: WEA Trust Commercial |
$2,635.05
|
| Rate for Payer: WPS Commercial |
$3,548.69
|
|
|
BLADE PRECISION FALCON OSC SAW 105MM 6725-127-105
|
Facility
|
OP
|
$2,775.00
|
|
| Hospital Charge Code |
4494459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$777.00 |
| Max. Negotiated Rate |
$11,100.00 |
| Rate for Payer: Aetna Commercial |
$2,497.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,386.50
|
| Rate for Payer: Aetna Managed Medicare |
$777.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,803.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,387.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,332.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,470.75
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$2,553.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,552.89
|
| Rate for Payer: Health EOS Commercial |
$2,469.75
|
| Rate for Payer: HFN Commercial |
$2,553.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,081.25
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,665.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,359.75
|
| Rate for Payer: Quartz Commercial |
$1,803.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,665.00
|
| Rate for Payer: The Alliance Commercial |
$11,100.00
|
| Rate for Payer: WEA Trust Commercial |
$1,526.25
|
| Rate for Payer: WPS Commercial |
$2,055.44
|
|
|
BLADE PRECISION FALCON OSC SAW 105MM 6725-127-105
|
Facility
|
IP
|
$2,775.00
|
|
| Hospital Charge Code |
4494459
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,359.75 |
| Max. Negotiated Rate |
$2,553.00 |
| Rate for Payer: Aetna Commercial |
$2,497.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,386.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,470.75
|
| Rate for Payer: Cash Price |
$832.50
|
| Rate for Payer: Cigna Commercial |
$2,553.00
|
| Rate for Payer: Health EOS Commercial |
$2,469.75
|
| Rate for Payer: HFN Commercial |
$2,553.00
|
| Rate for Payer: Multiplan Commercial |
$2,220.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,665.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,359.75
|
| Rate for Payer: Quartz Commercial |
$1,665.00
|
| Rate for Payer: WEA Trust Commercial |
$1,526.25
|
| Rate for Payer: WPS Commercial |
$2,055.44
|
|
|
BLADE PRECISION THIN 5.5X0.38X11.5MM 2296-003-410
|
Facility
|
IP
|
$583.00
|
|
| Hospital Charge Code |
5591258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$285.67 |
| Max. Negotiated Rate |
$536.36 |
| Rate for Payer: Aetna Commercial |
$524.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.99
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$536.36
|
| Rate for Payer: Health EOS Commercial |
$518.87
|
| Rate for Payer: HFN Commercial |
$536.36
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: NAPHCARE Commercial |
$349.80
|
| Rate for Payer: Preferred Network Access Commercial |
$536.36
|
| Rate for Payer: Quartz Beloit One Network |
$285.67
|
| Rate for Payer: Quartz Commercial |
$349.80
|
| Rate for Payer: WEA Trust Commercial |
$320.65
|
| Rate for Payer: WPS Commercial |
$431.83
|
|
|
BLADE PRECISION THIN 5.5X0.38X11.5MM 2296-003-410
|
Facility
|
OP
|
$583.00
|
|
| Hospital Charge Code |
5591258
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.24 |
| Max. Negotiated Rate |
$2,332.00 |
| Rate for Payer: Aetna Commercial |
$524.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.38
|
| Rate for Payer: Aetna Managed Medicare |
$163.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$378.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$291.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$279.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.99
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$536.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$326.25
|
| Rate for Payer: Health EOS Commercial |
$518.87
|
| Rate for Payer: HFN Commercial |
$536.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$437.25
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: NAPHCARE Commercial |
$349.80
|
| Rate for Payer: Preferred Network Access Commercial |
$536.36
|
| Rate for Payer: Quartz Beloit One Network |
$285.67
|
| Rate for Payer: Quartz Commercial |
$378.95
|
| Rate for Payer: Quartz Medicare Advantage |
$349.80
|
| Rate for Payer: The Alliance Commercial |
$2,332.00
|
| Rate for Payer: WEA Trust Commercial |
$320.65
|
| Rate for Payer: WPS Commercial |
$431.83
|
|
|
BLADE PRECISION THIN 7.0X0.38X18.5MM 2296-003-114
|
Facility
|
IP
|
$705.00
|
|
| Hospital Charge Code |
5459192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.45 |
| Max. Negotiated Rate |
$648.60 |
| Rate for Payer: Aetna Commercial |
$634.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.65
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna Commercial |
$648.60
|
| Rate for Payer: Health EOS Commercial |
$627.45
|
| Rate for Payer: HFN Commercial |
$648.60
|
| Rate for Payer: Multiplan Commercial |
$564.00
|
| Rate for Payer: NAPHCARE Commercial |
$423.00
|
| Rate for Payer: Preferred Network Access Commercial |
$648.60
|
| Rate for Payer: Quartz Beloit One Network |
$345.45
|
| Rate for Payer: Quartz Commercial |
$423.00
|
| Rate for Payer: WEA Trust Commercial |
$387.75
|
| Rate for Payer: WPS Commercial |
$522.19
|
|
|
BLADE PRECISION THIN 7.0X0.38X18.5MM 2296-003-114
|
Facility
|
OP
|
$705.00
|
|
| Hospital Charge Code |
5459192
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$197.40 |
| Max. Negotiated Rate |
$2,820.00 |
| Rate for Payer: Aetna Commercial |
$634.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$606.30
|
| Rate for Payer: Aetna Managed Medicare |
$197.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$458.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$352.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$338.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.65
|
| Rate for Payer: Cash Price |
$211.50
|
| Rate for Payer: Cigna Commercial |
$648.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$394.52
|
| Rate for Payer: Health EOS Commercial |
$627.45
|
| Rate for Payer: HFN Commercial |
$648.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$528.75
|
| Rate for Payer: Multiplan Commercial |
$564.00
|
| Rate for Payer: NAPHCARE Commercial |
$423.00
|
| Rate for Payer: Preferred Network Access Commercial |
$648.60
|
| Rate for Payer: Quartz Beloit One Network |
$345.45
|
| Rate for Payer: Quartz Commercial |
$458.25
|
| Rate for Payer: Quartz Medicare Advantage |
$423.00
|
| Rate for Payer: The Alliance Commercial |
$2,820.00
|
| Rate for Payer: WEA Trust Commercial |
$387.75
|
| Rate for Payer: WPS Commercial |
$522.19
|
|
|
BLADE PRECISION THIN 9.0X0.38X31.0MM 2296-003-255
|
Facility
|
IP
|
$732.00
|
|
| Hospital Charge Code |
5459191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$358.68 |
| Max. Negotiated Rate |
$673.44 |
| Rate for Payer: Aetna Commercial |
$658.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$387.96
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$673.44
|
| Rate for Payer: Health EOS Commercial |
$651.48
|
| Rate for Payer: HFN Commercial |
$673.44
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: NAPHCARE Commercial |
$439.20
|
| Rate for Payer: Preferred Network Access Commercial |
$673.44
|
| Rate for Payer: Quartz Beloit One Network |
$358.68
|
| Rate for Payer: Quartz Commercial |
$439.20
|
| Rate for Payer: WEA Trust Commercial |
$402.60
|
| Rate for Payer: WPS Commercial |
$542.19
|
|
|
BLADE PRECISION THIN 9.0X0.38X31.0MM 2296-003-255
|
Facility
|
OP
|
$732.00
|
|
| Hospital Charge Code |
5459191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.96 |
| Max. Negotiated Rate |
$2,928.00 |
| Rate for Payer: Aetna Commercial |
$658.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.52
|
| Rate for Payer: Aetna Managed Medicare |
$204.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$475.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$366.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$351.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$387.96
|
| Rate for Payer: Cash Price |
$219.60
|
| Rate for Payer: Cigna Commercial |
$673.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$409.63
|
| Rate for Payer: Health EOS Commercial |
$651.48
|
| Rate for Payer: HFN Commercial |
$673.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$549.00
|
| Rate for Payer: Multiplan Commercial |
$585.60
|
| Rate for Payer: NAPHCARE Commercial |
$439.20
|
| Rate for Payer: Preferred Network Access Commercial |
$673.44
|
| Rate for Payer: Quartz Beloit One Network |
$358.68
|
| Rate for Payer: Quartz Commercial |
$475.80
|
| Rate for Payer: Quartz Medicare Advantage |
$439.20
|
| Rate for Payer: The Alliance Commercial |
$2,928.00
|
| Rate for Payer: WEA Trust Commercial |
$402.60
|
| Rate for Payer: WPS Commercial |
$542.19
|
|
